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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345003013
Report Date: 05/16/2023
Date Signed: 05/16/2023 11:19:01 AM


Document Has Been Signed on 05/16/2023 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:ANGELS ASSISTED LIVINGFACILITY NUMBER:
345003013
ADMINISTRATOR:BHATIA, SIMRANJITFACILITY TYPE:
740
ADDRESS:1526 CRESTMONT DRTELEPHONE:
(916) 841-9449
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:6CENSUS: 6DATE:
05/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator: Simranjit BhatiaTIME COMPLETED:
11:40 AM
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On May 16, 2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived to conduct a prelicensing inspection. LPA was greeted with Administrator, Simranjit Bhatia, and allowed entry into the facility.

LPA toured the facility with Administrator. This facility has a fire clearance for 5 non-ambulatory residents and 1 bedridden resident. There are 5 resident bedrooms and 3 bathrooms. Water temperatures were within the required range at 120 degrees F. Showers have required nonskid mats. Kitchen is clean and organized. All knives and sharp objects are kept inaccessible to residents. All appliances in the kitchen are observed to be clean and operational. Toxins and cleaning supplies are to be kept in the laundry room. Medications will be kept locked by the entrance cabinet. Washer and dryer are in a separate room by the garage and are clean and noted to be operational. Backyard was clear of debris and hazards. Administrator tested fire alarms and are in working order. Fire extinguisher was last serviced on 02/15/2023. Facility has a fully stocked first aid kit.
Component III has been completed at this time with Administrator.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit interview was conducted with Administrator and a copy of this report will be left at the facility.

SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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